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The effects of therapeutic exercise with and without mobilization in participants with chronic ankle instability: a randomized controlled trial
Bolton C, Hale S, Telemeco T
Journal of Sport Rehabilitation 2021 Feb;30(2):206-213
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

CONTEXT: Manual therapy (MT) is reported to increase range of motion (ROM), improve balance, and decrease pain in individuals with chronic ankle instability (CAI). Additional literature is needed to examine the effectiveness of the addition of MT to a therapeutic exercise regimen in individuals with CAI. OBJECTIVE: To examine the combined effects of thrust joint manipulation (TJM) and exercise on function in participants reporting CAI. DESIGN: Randomized controlled trial. SETTING: Research laboratory. PARTICIPANTS: A convenience sample of 30 participants (mean age 237 (3.65) y; mean height 169.50 (9.50) cm; mean mass 66.48 (10.64) kg). INTERVENTION: Participants were randomly allocated to the exercise (n = 15) or exercise plus TJM group (n = 20) and completed an exercise program. The exercise plus TJM group also received MT at the talocrural, proximal, and distal tibiofibular joints in the first 3 sessions. MAIN OUTCOME MEASURES: Self-reported outcomes were recorded at baseline and follow-up using the Foot and Ankle Ability Measure (FAAM), the FAAM-Sport (FAAM-S) subscale, and the Ankle Joint Functional Assessment Tool (AJFAT). The side-hop test, figure-of-8 hop test, 3 directions of the Star Excursion Balance Test, and dorsiflexion ROM were also assessed at baseline and follow-up. RESULTS: Only the exercise plus TJM group demonstrated an improvement in weight- bearing dorsiflexion with the knee flexed following treatment (p = 0.02). For all outcome measures, except ROM, subjects improved significantly at follow-up regardless of group assignment (p <= 0.01). CONCLUSIONS: Our data suggest that rehabilitation of patients with CAI is related to improved ROM, function, and self-reported outcomes. This provides evidence that the addition of MT to exercise may enhance improvements in ROM as compared with exercise alone. Additional research is needed to identify optimal parameters to maximize therapeutic benefit.
Copyright Human Kinetics. Reprinted with permission from Human Kinetics (Champaign, IL).

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